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Heart Transplantation

Since completing our first heart transplant in 1986, The Ohio State University Wexner Medical Center has been the only adult heart transplant center in central Ohio.

Why choose Ohio State?

Experience:

Our Comprehensive Transplant Center has one of the largest organ transplant programs in the nation. We perform nearly 250 kidney, liver, pancreas, combined kidney/pancreas, heart, lung and bone marrow transplants each year. Since our program started in 1967, we have performed more than 7,900 lifesaving transplants. In July 2014, we performed our 400th heart transplant.

Leading-Edge Treatments:

Ohio State’s team of researchers was among the first in the nation to evaluate the use of cyclosporine, a drug that suppresses the immune system and dramatically improves the success of organ transplantation. Ohio State was also the fourth institution in the country certified to implant the temporary CardioWest™ Total Artificial Heart, which serves as a bridge to transplant for the most critically ill patients.

Research:

Our research teams are studying new methods to lengthen the amount of time a heart remains viable for transplantation.

Candidates

Candidates

Ischemic Cardiomyopathy: happens when an artery leading to the heart becomes narrowed or blocked for a short time and oxygen-rich blood cannot reach your heart. In most cases of ischemia, this temporary blood shortage to the heart causes pain in the chest (called angina pectoris). In certain other cases, there is no pain. These cases are called silent ischemia.

Non-ischemic Cardiomyopathy: predominately involves the heart's abnormal structure and function. It does not involve the hardening of arteries on the heart surface typically associated with ischemic cardiomyopathy.

Post-partum Cardiomyopathy: a rare type of heart failure that is diagnosed in women during the last month of pregnancy or within five months following delivery. The damage weakens the heart muscle and causes the heart to become enlarged. As a result, the heart can’t pump blood properly throughout the rest of the body.

Malignant Arrhythmias: abnormal electrical signals in the heart that cause impairment, preventing the heart from beating in an organized rhythm and may cause sudden cardiac death.

Intractable Angina: debilitating chest pain and/or discomfort that occurs during exercise and exertion that prevents living a meaningful quality of life and is not treatable by opening up more blood flow to the heart.

Screenings before transplant ensure that you are in good medical and psychological health and that you have the motivation and support to comply with treatment plans. Some conditions may prevent a heart transplant from being performed (including kidney, lung or liver disease; insulin-dependent diabetes with poor function of other organs; other types of blood vessel disease of the neck and leg). All patients must meet the chemical dependency requirements of the Ohio Solid Organ Transplantation Consortium.

Patient Process

Patient Process

A goal of our Comprehensive Transplant Center is to ensure our transplant patients experience a thorough continuity of services through the entire transplant process, including pre-transplant evaluation, communication throughout the waiting process, acute medical care during and following surgery, intensive outpatient treatment, post-transplant outpatient visits and ongoing telephone follow-up.

Referral Phase

Your own cardiologist will make a referral for you to be evaluated for transplantation appropriateness at Ohio State’s Ross Heart Hospital. You will need to notify your insurance company before making your initial evaluation appointment. Our pre-transplant office and hospital business office will work with you to determine insurance availability and precertification requirements. Heart transplant coordinators and business office staff then work together to meet insurance company requirements for evaluation and transplant procedure approval.

Clinic Evaluation Phase

You will first be seen by one of our heart failure specialists to determine if you are a transplant candidate. If you are, you will then be scheduled for a full outpatient clinic evaluation. There we will determine if there is a need for additional medical or surgical therapy before transplant evaluation testing is initiated.

You will next meet the transplant coordinator and be scheduled for evaluation testing. The evaluation includes extensive cardiovascular testing, in addition to other tests that evaluate your health. Transplant candidates should be in good overall health since immunosuppressant medications taken after transplant are hard on bones, kidneys and liver.

Heart transplant candidates are classified into four categories, depending on the severity of illness:

Status 1A: Critically ill, must have one of the following: on ventilator, a ventricular assist device or VAD (good for 30 days useable at any time post-VAD), VAD-related complication, intra-aortic balloon pump or multiple inotropic medications with a hemodynamic monitoring device placed

Status 1B: May be in the hospital or at home on continuous inotropic support (single inotrope)

Status 2: Stable patient at home on oral therapy

Status 7: Temporarily inactive (not accruing time, not able to be transplanted for multiple reasons, such as infection, recent surgery, personal issues, etc.)

Priority for donor hearts is given to the “sickest” patients first, starting with Status 1A.

As part of your evaluation, you will also have consultations with our social worker, infectious disease specialists and the transplant psychologist. Every patient being evaluated for a heart transplant will have a psychosocial assessment to help determine if you have the psychological stability, motivation and personal support to meet the challenges of transplantation.

Additionally, all patients must meet the chemical dependency requirements of the Ohio Solid Organ Transplantation Consortium. The use of tobacco, alcohol or illicit drugs is carefully examined. Patients who are dependent on alcohol or drugs must undergo at least six months of rehabilitation and demonstrate a minimum of six months of abstinence before being put on the heart recipient list.

Finally, the patient’s track record of compliance with medical appointments and medications will be assessed.

Candidacy Phase

Once your testing has been completed, your case is presented to the Heart Transplant Patient Selection Committee, which comprises cardiothoracic surgeons, transplant cardiologists, transplant coordinators, a social worker, an infectious disease specialist and a psychologist. This committee will determine if a heart transplant is the best course of action for you.

If the Heart Transplant Patient Selection Committee approves you for transplant listing, the final step involves approval by the Ohio Solid Organ Transplantation Consortium (OSOTC). When approved by the OSOTC, you are then listed for heart transplantation on the United Network for Organ Sharing national waiting list.

Active Wait List Phase

It is important to note that you are not on the waiting list for transplant until you are told so by your heart transplant coordinator. A letter is sent to your insurance company providing recommendations for transplantation and requesting approval.

Donors are matched to recipients according to blood type, size, severity of illness and geographic location. Your wait time could be from days to years.

Our heart failure physicians will continue to follow up with you while you are waiting. You must submit to random drug, nicotine and alcohol screenings.

You must be reachable by phone at all times. Your transplant team is receiving offers of hearts from organ procurement organizations and then relaying that information to your transplant surgeon and cardiologist. If an organ is a good match for you, you will be contacted immediately. You should always be within a two-hour drive of Columbus, due to tight time constraints of a transplant.

Transplant Phase

You should not eat or drink anything from the moment you are notified that a heart has been matched to you. You will be instructed to immediately come to The Ohio State University Wexner Medical Center for admission to the Ross Heart Hospital.

At the same time, one team of OSU surgeons will be traveling to the donor hospital to recover the donor heart. If the heart is found to not be suitable for you, we may decline it and you may be sent home. If the donor heart is found to be acceptable, the team will recover the organ and transport it back to Columbus. The heart needs to be transplanted within four to six hours after donor recovery.

At the same time, the recipient surgical team is preparing you for the heart’s arrival. You will undergo lab tests, receive an X-ray and begin immunosupression medications. You will then go to surgery. You will be in the operating room for approximately six hours.

Upon completion of the surgery, you will be taken to the Intensive Care Unit and closely monitored for complications. You will be on a ventilator, with multiple IVs and monitoring devices. Usually, you will be removed from the ventilator and out of bed within 24-48 hours post-operation.

Post-Transplant Phase

The average length of a hospital stay for a heart transplant patient is seven to 14 days. Post-transplant success depends on your ability to take multiple medications daily (up to 40 pills a day) and to maintain a rigorous follow-up schedule, especially early on. Exercising and eating a heart-healthy diet are also important.

Endomyocardial biopsies, used to diagnose rejection within the heart, are done weekly in the early post-transplant phase. They are done as an outpatient procedure and last about a half-hour. As time goes on, the biopsies are spread further apart; at five-years post-transplant, only a yearly biopsy is performed.

Some degree of rejection is normal and expected. To treat rejection, your medication may be adjusted or you may receive an IV treatment. Rejection is very treatable if detected early.

After clearance by your doctor, we encourage you to return to work. A licensed independent social worker specially trained in transplant will assist you in adjusting to lifestyle changes brought on by your disease and its treatment. And a registered dietitian will individualize your nutritional care and teach you about your dietary needs.

You will be followed and evaluated annually by our transplant team; your transplant coordinator will be an important part of your recovery.

Financial Assistance

Although patients are ultimately responsible for the costs associated with a transplant, financial resources are not the determining factor in selection for the transplant program. A transplant financial counselor, business office staff and transplant social workers assist you and your family with questions about insurance coverage for your transplant and post-transplant medications.

Treatment Team

Treatment Team

Our Comprehensive Transplant Center treatment team includes:

Transplant Cardiologist

This heart doctor who specializes in heart transplants will follow you before, during and after your transplant. He or she will complete a physical exam and discuss with you testing that is needed to prepare you for your heart transplant. He or she will also be performing heart biopsies after your transplant.

Infectious Disease Physician

Heart Transplant Coordinator

These are the nurses who will be your primary contact from the time you are referred for a transplant evaluation throughout your care at Ohio State’s Wexner Medical Center. They will help answer any questions you may have and assist you throughout your transplant experience.

Erin Bumgardner, RN, BSN, CCTC

Susan Montgomery, RN, BSN, CCTC

Emily Jarvis, RN, BSN, CCTC

Ventricular Assist Device Coordinator

These are the nurses who will be your primary contact from the time you are referred for a mechanical device throughout your care at Ohio State’s Wexner Medical Center. They will help educate you and your family as well as answer any questions you may have and assist you throughout your experience.

Abby Bergman, RN, BC, BSN

Kelly MacBrair, RN, BSN

Sherri Wissman, RN, BSN, CCTC

Social Worker / Psychologist

These professionals meet with you to evaluate your psychological readiness for transplantation.

Transplant Pharmacist

A transplant pharmacist is a pharmacist who specifically works with patients who have received a transplanted organ. This pharmacist has been trained to understand details about anti-rejection medications, works closely with your transplant physician to help manage your medications and helps answer medication questions you may have.

Erik Able

Pam Burcham

Kevin Kissling

Pharmacy Patient Assistance Coordinator

This professional offers assessment, linkage and referrals for assistance to patients who need certain medications and have high co-pays or no prescription drug coverage.

What is tissue typing?

Ohio State’s Tissue Typing Laboratory ensures that an organ is compatible with its recipient. The process involves matching a person’s unique configuration of six human leukocyte antigen (HLA) molecules with a potential pool of approximately 100 different varieties.

Cross-match testing helps prevent some types of organ rejection. The testing involves mixing cells from the donor’s and recipient’s serum to determine whether rejection-promoting antibodies will occur. This information helps your physicians plan for the right medication strategy to best control organ rejection.

Transplant support testing includes monitoring new drugs that patients use, testing to determine a patient’s overall ability to maintain a recipient’s organ and developing new tests to support many of the clinical aspects of transplantation.

Are there any support groups to join?

Buckeye GIFT (Giving Inspiration For Transplantation) Support Group, sponsored by Lifeline of Ohio, has open meetings providing support, education, awareness and advocacy for all individuals impacted by organ and tissue donation and transplantation including transplant candidates, recipients, donor families, living donors, medical professionals and families and friends of those touched by the Gift of Life.

There are multiple meeting locations throughout Ohio. To learn more, visit the Buckeye GIFT website or contact the Community Events/Volunteer Coordinator at Lifeline of Ohio, 800-525-5667, ext. 375.